Background: Capsule endoscopy (CE) is a non-invasive imaging modality designed to evaluate various small bowel pathologies. Failure to reach the cecum within the battery lifespan, termed incomplete examination, may result in inadequate testing and possibly delayed therapy. Several studies have attempted to evaluate the association between CE completion and opioid use. However, their results are conflicting. The aim of this meta-analysis is to evaluate the previously published literature on the association between opioid use and CE completion. Methods: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through June 1, 2018, to identify all studies that evaluated the association between CE completion and opioid use. We included studies that presented an odds ratio (OR) with a 95% confidence interval (CI) or presented the data sufficient to calculate the OR with a 95% CI. Statistical analysis was performed using the comprehensive meta-analysis (CMA), version 3 software. Results: Five studies with a total of 1,614 patients undergoing CE in the inpatient (IP) and outpatient (OP) setting were included in this study, 349 of which had an incomplete CE (21.6%). The pooled OR for CE completion is 0.50 (95% CI: 0.38-0.66, I2=36.9%) in opioid users compared to non-users. No publication bias was found using Egger's regression test. Conclusions: Our results indicate that patients on opioids are significantly less likely to have a complete CE examination compared to non-users. To our knowledge, this study represents the first meta-analysis to assess this association.

To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff [...]

Recent reports suggest that measuring the objective quality is very essential towards the success of colonoscopy. Several quality indicators (i.e. metrics) proposed in recent studies are implemented in software systems that compute real-time quality scores for routine screening colonoscopy. Most quality metrics are derived based on various temporal events occurred during the colonoscopy procedure. The location of the phase boundary between the insertion and the withdrawal phases and the amount of circumferential inspection are two such important temporal events. These two temporal events can be determined by analyzing various camera motions of the colonoscope. This dissertation put forward a novel method to estimate X, Y and Z directional motions of the colonoscope using motion vector templates. Since abnormalities of a WCE or a colonoscopy video can be found in a small number of frames (around 5% out of total frames), it is very helpful if a computer system can decide whether a frame has any mucosal abnormalities. Also, the number of detected abnormal lesions during a procedure is used as a quality indicator. Majority of the existing abnormal detection methods focus on detecting only one type of abnormality or the overall accuracies are somewhat low if the method tries to detect multiple abnormalities. Most abnormalities in endoscopy images have unique textures which are clearly distinguishable from normal textures. In this dissertation a new method is proposed that achieves the objective of detecting multiple abnormalities with a higher accuracy using a multi-texture analysis technique. The multi-texture analysis method is designed by representing WCE and colonoscopy image textures as textons.

Background: Before making any treatment decisions for patients with non-small cell lung cancer (NSCLC), it is crucial to determine whether the cancer has spread to the mediastinal lymph nodes (LNs). The preferred method for mediastinal staging is Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA). However, EBUS-TBNA has been reported to generate inconclusive results as much as 40% of the time. Since this jeopardizes good patient care, there is near-universal consensus on the need to develop and study a novel method for LN staging. Recent research has shown that AI and deep learning are used to accurately interpret images with comparisons to clinicians in radiology, pathology, and cardiology. Additionally, EBUS-Elastography is a novel modality which could be used as an adjunct to EBUS-TBNA for LN staging. This technology uses impedance ultrasonography to measure tissue stiffness. Methods: There are three parts to this thesis. The first part involved the training, validating, and testing NeuralSeg, a deep neural network, to predict LN malignancy based on B-mode EBUS-TBNA images. The second part of this thesis involves EBUS-Elastography, defining the blue colour threshold and the optimal SAR cut-off value based on the blue threshold that most accurately distinguished benign and malignant LN. Finally, this thesis's third part involves validating part II's findings. Results: Part I resulted in an overall accuracy of 80.63% (76.93% to 83.97%), a sensitivity of 43.23% (35.30% to 51.41%), a specificity of 96.91% (94.54% to 98.45%), a positive predictive value of 85.90% (76.81% to 91.80%), a negative predictive value of 79.68% (77.34% to 81.83%), and an AUC of 0.701 (0.646 to 0.755). Part II Level 60 was chosen as the blue threshold with an AUC of 0.89 (95% CI: 0.77-1.00), and the optimal SAR cut off was found to be 0.4959 with a sensitivity of 92.30% (95% CI: 62.10% to 99.60%) and a specificity of 76.50% (95% CI: 49.80% to 92.20%). Using the blue threshold and SAR cut-off, the results of part III resulted in an overall accuracy of 70.59% (95% (CI) 63.50% to 77.01%), the sensitivity of 43.04% (CI: 31.94% to 54.67%), and a specificity of 90.74% (CI: 83.63% to 95.47%). Conclusion: It was observed that both AI and AI-powered EBUS-Elastography achieved high specificities on larger sample sizes, indicative that these methods may be helpful in identifying LN malignancy. However, due to the novelty of these technologies, more extensive multi-centre studies must be conducted before these processes can be standardized. / Thesis / Master of Health Sciences (MSc) / Non-Small Cell Lung Cancer (NSCLC) treatment decisions are made using vital information by performing biopsies to collect tissue from the lymph nodes near the lungs. The current method is called Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA), which involves a scope with a fine needle attached to it. This scope is led down the airway and guided by ultrasound to obtain the tissue needed to determine whether the lymph nodes have cancerous tissue. If the lymph nodes contain cancerous tissue, the patient may need chemotherapy; however, lung surgery may be the best treatment option if they do not. Many factors impact how successfully these tissue samples can be obtained, such as the skill and experience of the surgeon. These factors often lead to inconclusive results, making it difficult to make correct treatment decisions. Novel technologies such as Artificial Intelligence and Elastography are being used to diagnose lung cancer by interpreting images and providing information on tissue stiffness. We trained an Artificial Intelligence program to predict malignancy based on EBUS-TBNA images. Additionally, we trained the AI program to analyze Elastography images to aid us in understanding the relationship between the colour pattern of the elastography images and cancerous tissue. This thesis assesses how these novel technologies contribute to lung cancer diagnosis.

Surgical procedures conducted without proper guidance and dynamic feedback mechanism could lead to unintended consequences. In-vivo diagnostics and imaging (the Gastro-Intestinal tract) has shown to be inconvenient for the patients using traditional endoscopic instruments and often these conventional methods are limited in terms of their access to various organs (e.g. small intestines). Embedding sensors inside the living body is complex and further the communication with the implanted sensors is challenging using the current RF technology. Additionally, continuous replacement and/or batteries recharging for wireless sensors networks both in-vivo and ex-vivo adds towards the complexity. Advances in diagnostics and prognostics techniques require development at multiple levels through systems approach, guided by the futuristic intelligent decision making environment that reduces the human interference. The demands are not only at the component level, but also at the connectivity of the components such that secure, sustainable, self-reliant, and intelligent environment can be realized. This thesis provides important breakthroughs required to achieve the vision of intelligent healthcare environment. The research contributions of this thesis provide foundation for developing a new architecture for continuous medical diagnostic and monitoring. The chapters in this thesis cover four fundamental technologies covering the in-vivo imaging, ex-vivo imaging, energy for sensors, and acoustic communication. These technologies are: locomotion mechanism for wireless capsule endoscope (WCE), multifunctional image guided surgical (MIGS) platform, shape memory alloy (SMA) thermal energy harvester and thermo-acoustic sonar using carbon nanotube (CNT) sheets. First, two types of locomotion mechanisms were developed, the first one inspired by millipede legged type mechanism and the second one based on the traveling waves that were induced onto the walls of the WCEs through vibration. Both mechanisms utilize piezoelectric actuators and couple their dynamics and actuation capability in order to achieve propulsion. This controlled locomotion will provide WCE advantage in terms of conducting localized diagnostics. Next, in order to conduct ex-vivo surgical procedures using the OCT such as removing the unwanted tissue and tumors short distance beneath the skin, MIGS platform was developed. The MIGS platform is composed of three key elements: optical coherence tomography (OCT) probe, laser scalpel and high precision miniature scanning and positioning stage. The focus in this dissertation was on design and development of the programmable scanning and positioning stage. The combination of in-vivo tool such as WCE and ex-vivo tool such as MIGS will provide opportunity to conduct many non-invasive procedures which will save time and cost. In order to power the feedback sensors that assist in remote operation of surgical procedures and automation of the diagnostic algorithms, an energy harvester technology based on the SMA thermal engine was designed, fabricated, and characterized. A mechano-thermal model for the overall SMA engine was developed and experimentally validated. Finally, the thermo-acoustic sound generation mechanism using CNT sheets was investigated with the goal of developing techniques for acoustic localization of WCE and customized sound generation devices. CNT thermo-acoustic projectors were modeled and experimentally characterized to quantify the dynamics of the system under varying drive conditions. The overall vision of this thesis is to lay down the foundation for intelligent healthcare environment that provides the ability to conduct automated diagnostics, prognostics, and non-invasive surgical procedures. In accomplishing this vision, the thesis has addressed several key fundamental aspects of various technologies that will be required for implementing the automation algorithms. / Ph. D.

INTRODUÇÃO: O esôfago de Barrett (EB) é uma patologia que aumenta substancialmente o risco de adenocarcinoma esofágico. Os pacientes portadores de EB devem ser seguidos ao longo de toda a vida na tentativa da detecção de neoplasia em estágio precoce. A endoscopia digestiva alta (EDA) é, atualmente, o método de eleição. OBJETIVO: Avaliar a eficácia da cápsula endoscópica do esôfago (CEE) comparada à EDA com cromoscopia com azul de metileno para detecção de lesões suspeitas de neoplasia esofágica, avaliação da extensão e padrão do EB, e identificação da presença de hérnia de hiato; além de comparar a segurança e grau de desconforto dos dois métodos. MÉTODOS: Estudo de casos transversal, realizado em 22 pacientes sabidamente portadores de EB que foram submetidos à fundoplicatura à Nissen há mais de 5 anos. Os pacientes realizaram os exames de CEE e EDA com cromoscopia esofágica por médicos diferentes e desconhecedores dos achados do outro exame. Após a realização dos exames, foi aplicado um questionário onde foi anotado o grau de desconforto do paciente em cada exame e eventuais complicações. Foi avaliado o índice de concordância (kappa) entre os dois métodos para pesquisa de lesões suspeitas de neoplasia esofágica, características do EB e detecção de hérnia hiatal. RESULTADOS: Dezenove pacientes completaram o estudo. A CEE apresentou sensibilidade e valor preditivo negativo de 100% e acurácia de 79% para detecção de lesão suspeita de neoplasia esofágica e concordância razoável com EDA (kappa = 0,27). A acurácia da CEE para avaliação da extensão do EB foi de 89% e concordância moderada (kappa = 0,60) com EDA. A acurácia da CEE para avaliação de EB digitiforme, circunferencial e misto foram, respectivamente, 74%, 79% e 74% com concordância moderada nos casos de EB circunferencial e misto e não significante no EB digitiforme. Quanto à detecção de hérnia de hiato a CEE apresentou sensibilidade de 43% e acurácia de 74%, com concordância razoável (kappa = 0,38) com EDA. Não houve diferença estatística de desconforto entre os exames e não houve complicação em ambos os métodos endoscópicos. CONCLUSÕES: A CEE mostrou-se um bom método de detecção de lesões suspeitas de neoplasia esofágica. Quanto a avaliação da extensão e padrão do EB, a CEE apresentou resultados razoáveis, quando comparada à EDA com cromoscopia esofágica. A CEE apresentou resultados insatisfatórios quanto à detecção de hérnia hiatal. Não houve diferença significativa de desconforto entre CEE e EDA. Os dois métodos mostraram-se seguros / INTRODUCTION: Barrett\'s esophagus (BE) is a condition that substantially increases the risk of esophageal adenocarcinoma. Patients with BE should be followed throughout life in an attempt to detect cancer at an early stage. Upper gastrointestinal endoscopy (GIE) is currently the method of choice. OBJECTIVE: To evaluate the efficacy of esophageal capsule endoscopy (ECE) compared to methylene blue (MB) chromoendoscopy for detection of suspicious lesions of esophageal cancer, evaluation of extent and pattern of BE, and identifying the presence of hiatal hernia, in addition to compare the safety and patients discomfort of the two methods. METHODS: Transverse study, conducted on 22 Barretts patients submitted to Nissen fundoplication with more than five years follow-up. Patients underwent examinations of ECE and MB chromoendoscopy by different physicians blinds to each procedures. After the exams, patients discomfort and possible complications that occurred in each method were recorded. It was evaluated the concordance index between the two methods for detection of suspicious lesions of esophageal cancer, extent and pattern of BE and hiatal hernia detection. RESULTS: Nineteen patients completed the study. The ECE sensitivity, negative predictive value and accuracy were, respectively, 100%, 100% and 79% for detecting suspicious lesion of esophageal cancer and had reasonable agreement with MB chromoendoscopy (kappa = 0.27). The ECE accuracy for assessing the extent of BE was 89% and had moderate agreement (kappa = 0.60) with MB chromoendoscopy. The accuracy of the ECE for evaluation of finger-like, circumferential, and mixed BE were respectively 74%, 79% and 74%, and moderate agreement in cases of circumferencial and mixed BE and not significant agreement for finger-like BE. ECE sensitivity and accuracy for detecting hiatal hernia were, respectively, 43 % and 74%, and fair agreement (kappa = 0.38) with MB chromoendoscopy. There was no statistical difference between the discomfort of examinations and there was no complication in both endoscopic methods. CONCLUSIONS: The ECE has proved to be a good method for detecting suspicious lesions of esophageal cancer. As the evaluation of the extent and pattern of BE, the ECE had reasonable results, when compared to MB chromoendoscopy. The ECE had unsatisfactory results regarding the detection of hiatal hernia. There was no significant difference in discomfort between the ECE and GIE. Both methods proved to be safe

Made available in DSpace on 2015-07-22T20:49:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-31. Added 1 bitstream(s) on 2015-08-11T03:25:33Z : No. of bitstreams: 1 Publico-0144.pdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A cirurgia dos tumores selares é tradicionalmente um campo de atuação dos neurocirurgiões. Contudo, desde a retomada da abordagem transeptaltransesfenoidal para acessar a sela túrcica, na década de sessenta do século passado, os otorrinolaringologistas têm exercido importante parceria neste procedimento. A divulgação da cirurgia endoscópica nasossinusal na otorrinolaringologia criou o interesse pela sua aplicação na cirurgia da região selar. a uso do endoscópio permitiu acesso transnasal direto ao seio esfenoidal sem a necessidade de descolamento do septo nasal, com menor desconforto para o paciente, além de morbidade pós-operatória inferior aos métodos tradicionais. Objetivo: O objetivo deste trabalho foi verificar as dificuldades técnicas, intercorrências e complicações pós-operatórias, no manejo otorrinolaringológico do acesso transnasal endoscópico à sela túrcica. Método: Foram analisados retrospectivamente os prontuários e imagens de arquivo de 159 pacientes submetidos à cirurgia da região selar entre março de 2001 e dezembro de 2005, na Universidade Federal de São Paulo / Escola Paulista de Medicina. Foram incluídos neste estudo 91 pacientes submetidos a um total de 95 procedimentos por via transnasal endoscópica. Resultados: Foi possível a realização da técnica endoscópica transnasal em todos os pacientes estudados, independente de idade, presença de variações anatômicas, características e etiologia do tumor, e antecedente de cirurgia prévia. Não houve necessidade de remoção da concha média ou correção de desvios septais para realização do procedimento cirúrgico em nenhum dos casos. A principal intercorrência foi a abertura do diafragma selar durante a remoção de tumores, causando fístula liquórica intra-operatória em 13,68 por cento dos casos. As complicações pós-operatórias encontradas foram: sangramento nasal (8,42 por cento), fístula liquórica (8,42 por cento), e meningite (2,19 por cento). Conclusão: O acesso endoscópico transnasal aos tumores selares pôde ser realizado de forma minimamente invasiva, preservando-se as estruturas nasais nos 95 procedimentos estudados, independente da idade do paciente, características e etiologia do tumor. / Sellar tumor surgery is traditionally a neurosurgeon´s field. However, since the renewed interest in the transseptal-transsphenoidal approach to access the sellar region in the sixties, otolarynngologists have played an important partnership in this procedure. Divulging of endoscopic sinus surgery in otolaryngology created an interest in its application in sellar region surgery. The use of endoscopes allowed a direct transnasal approach to the sphenoidal sinus without need of dissection of the septal mucosa, with less post-operative discomfort and morbidity inferior to that of traditional methods. Objective: The objective of this work was to verify the technical difficulties, intercurrences and post-operative complications in the otolaryngological handling of the endoscopic transnasal approach to the sellar region. Method: The analisys comprised both the files and archive images of 159 patients submitted to sellar region surgery between march 2001 and December 2005, at Universidade Federal de São Paulo / Escola Paulista de Medicina. 91 patients submitted to a total of 95 endoscopic transnasal procedures were included in this study. Results: It was possible to apply the endoscopic transnasal tecnique in all studied patients, independent of age, anatomical variations, tumor characteristics and etyology, and previous surgery history. There was no need of middle turbinate removal, or septal deviations corrections for the surgical procedure in any of the cases. The main intercurrence was the opening of the sellar diaphragm during the removal of the the tumors, causing intra-operative CSF leak in 13.68% of the cases. The post-operative complications encountered were: nasal bleeding (8.42%), CSF leak (8,42%), and meningitis (2.19%). Conclusion: Transnasal endoscopic approach to sellar tumors was done in a minimally invasive form, preserving the nasal structures in the 95 studied procedures, independently of patient age, tumor characteristics and etyology. / TEDE / BV UNIFESP: Teses e dissertações

INTRODUÇÃO: O esôfago de Barrett (EB) é uma patologia que aumenta substancialmente o risco de adenocarcinoma esofágico. Os pacientes portadores de EB devem ser seguidos ao longo de toda a vida na tentativa da detecção de neoplasia em estágio precoce. A endoscopia digestiva alta (EDA) é, atualmente, o método de eleição. OBJETIVO: Avaliar a eficácia da cápsula endoscópica do esôfago (CEE) comparada à EDA com cromoscopia com azul de metileno para detecção de lesões suspeitas de neoplasia esofágica, avaliação da extensão e padrão do EB, e identificação da presença de hérnia de hiato; além de comparar a segurança e grau de desconforto dos dois métodos. MÉTODOS: Estudo de casos transversal, realizado em 22 pacientes sabidamente portadores de EB que foram submetidos à fundoplicatura à Nissen há mais de 5 anos. Os pacientes realizaram os exames de CEE e EDA com cromoscopia esofágica por médicos diferentes e desconhecedores dos achados do outro exame. Após a realização dos exames, foi aplicado um questionário onde foi anotado o grau de desconforto do paciente em cada exame e eventuais complicações. Foi avaliado o índice de concordância (kappa) entre os dois métodos para pesquisa de lesões suspeitas de neoplasia esofágica, características do EB e detecção de hérnia hiatal. RESULTADOS: Dezenove pacientes completaram o estudo. A CEE apresentou sensibilidade e valor preditivo negativo de 100% e acurácia de 79% para detecção de lesão suspeita de neoplasia esofágica e concordância razoável com EDA (kappa = 0,27). A acurácia da CEE para avaliação da extensão do EB foi de 89% e concordância moderada (kappa = 0,60) com EDA. A acurácia da CEE para avaliação de EB digitiforme, circunferencial e misto foram, respectivamente, 74%, 79% e 74% com concordância moderada nos casos de EB circunferencial e misto e não significante no EB digitiforme. Quanto à detecção de hérnia de hiato a CEE apresentou sensibilidade de 43% e acurácia de 74%, com concordância razoável (kappa = 0,38) com EDA. Não houve diferença estatística de desconforto entre os exames e não houve complicação em ambos os métodos endoscópicos. CONCLUSÕES: A CEE mostrou-se um bom método de detecção de lesões suspeitas de neoplasia esofágica. Quanto a avaliação da extensão e padrão do EB, a CEE apresentou resultados razoáveis, quando comparada à EDA com cromoscopia esofágica. A CEE apresentou resultados insatisfatórios quanto à detecção de hérnia hiatal. Não houve diferença significativa de desconforto entre CEE e EDA. Os dois métodos mostraram-se seguros / INTRODUCTION: Barrett\'s esophagus (BE) is a condition that substantially increases the risk of esophageal adenocarcinoma. Patients with BE should be followed throughout life in an attempt to detect cancer at an early stage. Upper gastrointestinal endoscopy (GIE) is currently the method of choice. OBJECTIVE: To evaluate the efficacy of esophageal capsule endoscopy (ECE) compared to methylene blue (MB) chromoendoscopy for detection of suspicious lesions of esophageal cancer, evaluation of extent and pattern of BE, and identifying the presence of hiatal hernia, in addition to compare the safety and patients discomfort of the two methods. METHODS: Transverse study, conducted on 22 Barretts patients submitted to Nissen fundoplication with more than five years follow-up. Patients underwent examinations of ECE and MB chromoendoscopy by different physicians blinds to each procedures. After the exams, patients discomfort and possible complications that occurred in each method were recorded. It was evaluated the concordance index between the two methods for detection of suspicious lesions of esophageal cancer, extent and pattern of BE and hiatal hernia detection. RESULTS: Nineteen patients completed the study. The ECE sensitivity, negative predictive value and accuracy were, respectively, 100%, 100% and 79% for detecting suspicious lesion of esophageal cancer and had reasonable agreement with MB chromoendoscopy (kappa = 0.27). The ECE accuracy for assessing the extent of BE was 89% and had moderate agreement (kappa = 0.60) with MB chromoendoscopy. The accuracy of the ECE for evaluation of finger-like, circumferential, and mixed BE were respectively 74%, 79% and 74%, and moderate agreement in cases of circumferencial and mixed BE and not significant agreement for finger-like BE. ECE sensitivity and accuracy for detecting hiatal hernia were, respectively, 43 % and 74%, and fair agreement (kappa = 0.38) with MB chromoendoscopy. There was no statistical difference between the discomfort of examinations and there was no complication in both endoscopic methods. CONCLUSIONS: The ECE has proved to be a good method for detecting suspicious lesions of esophageal cancer. As the evaluation of the extent and pattern of BE, the ECE had reasonable results, when compared to MB chromoendoscopy. The ECE had unsatisfactory results regarding the detection of hiatal hernia. There was no significant difference in discomfort between the ECE and GIE. Both methods proved to be safe

No description available.

Introdução: O câncer de esôfago (CaE) ocorre em 22% dos casos como doença local, e a minoria dessa doença é limitada à mucosa ou à submucosa (lesões precoces). Ressecção endoscópica da mucosa (EMR), dissecção submucosa endoscópica (ESD), terapia fotodinâmica (PDT), terapia a laser e coagulação com plasma de argônio (APC) têm sido desenvolvidas como alternativas à ressecção cirúrgica de lesões precoces. Objetivos: Identificar, por meio de revisão sistemática, estudos que reportem sobrevida, sobrevida livre de doença, morbidade e mortalidade associada ao procedimento e mortalidade associada ao câncer em terapias endoscópicas e cirúrgicas no câncer de esôfago limitado à mucosa ou à submucosa (lesões precoces). Fontes de dados: Uma revisão sistemática de artigos em MEDLINE, Registro Cochrane de Ensaios Clínicos Controlados, EMBASE, EBSCO, LILACS, Biblioteca da Universidade de São Paulo e em sites de pesquisa, como BVS e SCOPE ScienceDirect. Seleção do estudo: Ensaio Controlado Aleatório, Ensaio Clínico Controlado, Ensaio Clínico e Estudos de Coorte. Critérios de seleção: Estudos que comparam estatisticamente a sobrevida e a sobrevida livre de doença, a morbidade e a mortalidade associada ao procedimento e a mortalidade associada ao câncer no tratamento endoscópico e cirúrgico para lesões precoces do câncer de esôfago. Extração de dados: Extração independente de dados de artigos por dois autores, incluindo os indicadores de qualidade dos estudos. Na busca, não foi encontrado nenhum tipo de ensaio clínico; portanto, extraímos apenas estudos comparativos retrospectivos e os resultados extraídos forma analisados estatisticamente. Limitação: Apenas estudos prospectivos, comparando as terapias endoscópicas e cirúrgicas, bem como as terapias reportadas com heterogeneidade. Resultados: Em estudos comparando as terapias cirúrgica e endoscópica na mortalidade relacionada ao procedimento, a diferença não foi significativa; nas taxas de sobrevivência após 1, 2, 3, 4 e 5 anos, foram diferentes e mostraram superioridade da cirurgia ao longo do tempo, estas foram aparentemente influenciadas por vieses na população. Ao suprimir esse viés, a endoscopia é superior no controle da mortalidade relacionada ao câncer com alta taxa de recidiva da doença. Em relação à comorbidade e à mortalidade associada ao procedimento, a endoscopia apresenta melhores resultados. Conclusões e implicações: Não existem evidências reportadas de ensaios clínicos. Nesta metanálise, as terapias cirúrgicas mostraram superioridade na sobrevida, e as terapias endoscópicas apresentaram superioridade no controle da mortalidade relacionada ao câncer, mas com alta taxa de recorrência da doença, a comorbidade e a mortalidade associadas à endoscopia é menor. Ensaios controlados com volume amostral expressivo são necessários para confirmar os resultados da metanálise atual. Número de registro de revisão sistemática: CRD42014013170 / Esophageal cancer occurs in 22% of cases as a local disease, and a minority of this disease is limited to mucosa or submucosa (early lesions). Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), photodynamic therapy (PDT), laser therapy, and argon plasma coagulation (APC) have been developed as alternatives to surgical resection for early lesions. Objectives: The aim of this systematic review is to identify studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated to cancer in the endoscopic and surgical therapies. Data sources: A systematic review of English and non-English articles using MEDLINE and the Cochrane Controlled Trials Register, EMBASE, EBSCO, LILACS, Library University of São Paulo, Research websites BVS and SCOPE ScienceDirect. Study selection: Randomized Controlled Trial, Controlled Clinical Trial, Clinical Trial and Cohort Study. Criteria: Studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated to cancer in the endoscopic and surgical therapies for early lesions of esophageal cancer. Data extraction: Independent extraction of articles by two authors using predefined data fields, including study quality indicators. In the search, I did not find any type of clinical trial; therefore, I extracted only retrospective comparative studies and analyzed statistically the results extracted. Limitation: Only prospective studies comparing the endoscopy and surgery therapies with heterogeneity. Results: Studies comparing surgical and endoscopic therapies showed in the procedure-related mortality, the difference was not significant; in the survival rates after 1, 2, 3, 4 and 5 years were different and showed superiority of surgical therapies over time, these were apparently influenced by biases in selection of population, when this bias is removed, endoscopy is superior in control of mortality related to cancer with a high rate of disease recurrence; in regard to comorbidity and mortality associated with the procedure, endoscopy is superior. Conclusions and implications: There is no evidence from clinical trials. In these meta-analyses, surgical therapies showed superiority in survival, and endoscopic therapies showed superiority in control of mortality related to cancer with a high rate of disease recurrence; also, comorbidity and mortality associated with endoscopy are superior. Prospective, controlled trials with large sample sizes are required to confirm the results of this current meta-analysis. Systematic review registration number: CRD42014013170